Professional Documents
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(a) To provide an authorised and cost effective health insurance scheme for
eligible staff;
(b) To ensure that only eligible staff become members of the scheme;
(c) To ensure that premiums paid by the company are correctly calculated,
authorised, relative to actual membership, accounted for, and are competitive;
(d) To ensure that any additional contributions made by employees are
correctly calculated, received and paid over to the scheme;
(e) To ensure that the provision of the scheme fully complies with all the
relevant legislation and taxation regulations;
(f) To ensure that claims against the scheme are correctly routed and dealt
with;
(g) To prevent the processing of invalid or excessive claims so as to contain
the operating costs to the organisation; and
(h) To ensure that management periodically review the performance and costs
of the scheme so as to ensure that it continues to represent good value for money.
1 Key Issues
1.1 Has the scheme been suitably authorised and the costs justified and
negotiated on the best terms?
1.2 Have appropriate membership eligibility rules been established, and
are only eligible employees accepted for membership at the appropriate
time?
1.3 How can management be assured that the operation of the scheme
complies with all the relevant legislation and current taxation regulations?
1.4 How are the organisations premiums calculated and does this
process represent the actual level/type of membership?
1.5 How can management be sure that he premiums represent good
value for money and that they are competitive (i.e. are they subject to
review by management upon renewal)?
1.6 Are all premium payments authorised, recorded and adequately
accounted for?
1.7 Are all scheme claims assessed for validity and recorded as passed
over to the scheme providers?
1.8 Are excessive or invalid claims identified and prevented from being
processed?
2 Detailed Issues